Category Archives: Nursing

Symptoms of Diabetes

(Guide only, type 2 diabetes can be asymptomatic for years)

Symptoms Type 1 Diabetes Type 2 Diabetes
Onset Fast (days/weeks) Slow (months/years)
Thirst √ often profound √
Polyuria/nocturia √ √
Bedwetting in children √  -
Lethargy/tiredness √ √
Mood changes/irritability √ √
Weight loss √++ √+/-
Visual disturbances √ √
Thrush infections (genital) - √
Recurrent infections (boils/ulcers) - √
Hunger √ √
Tingling/pain/numbness in extremities - √
Occasionally abdominal pain √ -
Confusion If advanced √ Especially in the elderly
Incontinence - √ Especially in the elderly
Glucosuria √ May be absent especially in the elderly or if there is a high renal threshold
Ketones in urine or blood May be present (ketoacidosis) Likely to be present

Thanks to Practice Nurse 41 8

Symptoms of TIA

Definite Probably Not Alarm symptoms (may require admission)
Slurring Dizziness Known AF; or high stroke risk
Clumsiness Confusion Recurrent TIAs; more than 2 in last 2 weeks
Tingling/numbness General weakness Patient on anticoagulant. May need brain scan
Visual disturbance ABCD2 score of 4 or more

Thanks to Practice Nurse 41 8

Treating Mild Hypoglycaemia

To raise blood glucose, take one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

If blood glucose is still below 4mmol/l after 10 mins, or if patient doesn’t feel better, repeat one of the above treatments.

When feeling better, eat some starchy food such as a sandwich or a banana, monitoring blood glucose afterwards.

Coeliac Disease

This is an autoimmune condition triggered by the consumption of gluten found in wheat, barley, rye and occasionally oats. Frequently there is confusion of a patient’s symptoms, sometimes leading to a diagnosis of IBS or wheat intolerance. Untreated celiac disease can lead to increased risk of osteoporosis and small bowel cancer.

Symptoms of celiac disease include:

  • Nausea
  • Bloating
  • Flatulence
  • Constipation
  • Diarrhoea
  • Weight loss
  • Fatigue
  • Joint or bone pain
  • Mouth ulcers
  • Dematitis herpetiformis (a skin condition associated with coeliac disease)

Coeliac disease is diagnosed first of all with a blood test for immunoglobulin A or tissue transglutaminase amtonpdoes (tTGA). If this proves inconclusive. Endomysial antibodies may also be tested for, and later with an endoscopy and biopsy of the duodenum.

Gluten-free food including pasta, flour, biscuits, crackers and even breads and pizza bases are available on prescription.

Interpretation of ABPI

  • 1.3 or above may indicate arterial disease or calcification. Seek advice from tissue viability nurse
  • 1.0-1.3 normal arterial flow. Regular compression is probably safe, if not otherwise contraindicated
  • 0.8-1.0 Mild arterial disease, but sufficient for compression if not otherwise contraindicated
  • 0.5-0.8 Moderate arterial insufficiency. Seek advice from tissue viability nurse; reduced compression may be appropriate following specialist advice

Korotkoff Sounds

  • Phase I – the initial appeance of faint, repetitive tapping sounds that grandually increase in intensity for at least two consecutive beats (the systolic blood pressure)
  • Phase II – a brief period during which the sounds soften and acquire a swishing quality. In some patients the sounds may even disappear briefly. This is known as an auscultatory gap
  • Phase III – the return of sharper sounds, which may even be stronger than those in Phase I
  • Phase IV – distinct, abrupt muffling sounds that become soft and blowing in quality
  • Phase V – all sounds finally disappearing (the point of diastolic blood pressure)

Thanks to Nursing in Practice 62 (2011)

Medical Research Council Dyspnoea Scale

  • Grade 1 – not troubled by breathlessness except during strenuous exercise
  • Grade 2 – short of breath when hurrying or walking up a slight hill
  • Grade 3 – walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
  • Grade 4 – stops for breath after walking about 100m or after a few minutes on the level
  • Grade 5 – too breathless to leave the house, or breathless when dressing or undressing